WASHINGTON, D.C. - Two new studies published today in The Lancet have demonstrated that a 4 percent chlorhexidine solution is an effective intervention to reduce neonatal infection and mortality when applied to the umbilical cord within hours of birth.

Neonatal deaths account for more than 40 percent of estimated 8.8 million deaths of children under 5 each year worldwide. In high mortality settings, more than half of those neonate deaths are the result of serious infection.

In rural Bangladesh, over 29,000 newborns were enrolled in a randomized trial to determine the effectiveness of single or 7-day cleansing with 4 percent chlorhexidine compared to the standard dry cord care. Cleansing a newborn's umbilical cord with chlorhexidine reduced an infant's risk of infection and death by 20 percent. Reductions in mortality were not statistically significant among the 7-day cleansing group compared to dry care, but they did have fewer signs of cord infection. The study, led by researchers at the Johns Hopkins Bloomberg School of Public Health and funded in partnership with Save the Children's Saving Newborn Lives program, is the latest in series of studies showing that umbilical cord cleaning with chlorhexidine can save lives.

In the second study, researchers from Aga Khan University (AKU) in Pakistan assessed the effect of umbilical-cord cleansing with 4 percent chlorhexidine solution, with or without handwashing with antiseptic soap, on umbilical cord infection and neonatal mortality. In a sample of 9,741 newborns in rural areas, cord cleansing reduced the risk of infection in babies by 42 percent and mortality by 38 percent. "Our study not only provides the evidence that a simple low-cost solution like chlorhexidine can save lives, but also shows that a delivery strategy through packaging in birth kits works," said Professor Zulfiqar A. Bhutta, head of the Division of Women and Child Health at AKU, and principal investigator of the study.

These studies support earlier research in Nepal where cleansing the umbilical cord with chlorhexidine for 7 days of the first 10 days of life resulted in a 24 percent decrease in mortality compared to children who received dry-cord umbilical care. A pilot project in the Banke district of Nepal done in parallel with the Bangladesh and Pakistan studies demonstrated that cord cleansing with 4 percent chlorhexidine can be successfully incorporated in maternal and newborn care programs using the existing cadre of Female Community Health Volunteers. Based upon these results USAID, through the Saving Lives at Birth Grand Challenges for Development, in partnership with the government of Nepal is supporting the first national scale-up of chlorhexidine in-country.

"Giving birth and a child's first week is a risky time for a mother and her newborn," said Dr. Rajiv Shah, the Administrator of the U.S. Agency for International Development. "These studies provide evidence of a simple, low-cost technology that can prevent illness and death for the most vulnerable children. USAID is committed to transforming research into better results and access to life saving interventions."

The adoption and application of chlorhexidine in high risk, low resource settings has the potential to drastically reduce neonatal mortality. The application of chlorhexidine requires minimal training and can be easily administered in various settings, including the home. Chlorhexidine can be delivered to women through existing health services as well as through retail outlets and by community health workers. As noted by Dr Abdullah Baqui, senior author of the Bangladesh study "Chlorhexidine cord cleansing is a simple, safe, effective, and inexpensive intervention. Large scale implementation of this intervention with high coverage has the potential to avert an estimated half a million neonatal deaths per year".

The U.S. Agency for International Development (USAID) funded the two new Lancet studies.

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